A process evaluation of newly implementing South African roadside wellness clinics for truck drivers
Lalla-Edward, Samantha Tresha
Truck drivers have specific healthcare needs. South African policy priotitises truck drivers for service delivery, as part of the country’s HIV response. A nongovernmental organisation, North Star Alliance has established roadside wellness centres (RWCs) providing healthcare to truckers, sex workers and communities along transport corridors. North Star commissioned an evaluation of their services through a project called the North South Corridor Demonstration Project (NSCDP). A subset of the NSCDP is presented in this thesis and contributes one of the first reports that comprehensively contextualizes truck driver health programming in the region The evaluation includes a systematic review of evaluations of truck driver health care interventions in the region; accessibility and appropriateness of the RWCs; and exploring truck drivers’ healthcare seeking behaviour. The evaluation adopted a programme logic model for a mixed-methods approach using programme data for the South African (SA) Department of Health reporting routinely collected data (n=13 252 records), individual interviews (n=46), and longitudinal data for nine SA RWCs. An adapted continuum of HIV care (access, utilisation, linkage, retention) conceptual framework was used to organise the thesis. Access: Truck drivers were predominantly young SA men in stable relationships and reported relatively low sexual risk-taking. Truck drivers reported complex and stressful lifestyles. They found the services highly acceptable but provided recommendations. Utilisation: Truck drivers mainly accessed non-HIV primary healthcare services (65%; 11 001/17 885). Linkage and retention in care: Of 5 548 tested for HIV. 4% were positive, with 57% (59/104 clients with CD4 testing) were eligible for antiretroviral treatment at the then initiation threshold of 500 cells/uL. RWCs had an average monthly ART initiation rate of 7.7 and a retention rate of 54% (among those who consented for follow-up). The unit cost per client initiated and in care was approximately ZAR878. Comprehensive care packages (incorporating mental health service; other noncommunicable diseases and addressing occupational requirements) delivered through accessible satellite facilities should form the foundation of service delivery models for truck drivers.
Original published work submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy, Johannesburg, June 2018